Clinical guidelines are very popular, as they should be, in trying to disseminate appropriate care. Unfortunately, these are often portrayed as clear-cut and indisputable. Unfortunately, the truth is that there is just as much debate and disagreement about them as most other things in medicine. There are numerous examples of multiple available guidelines for a given topic that are mutually incompatible. It is important to realize that these are products of a human process that is (1) imperfect and (2) in its infancy. Guidelines for Guidelines: Measuring Trustworthiness by David F. Ransohoff and Harold C. Sox.

The peer-review process in publishing scientific articles in health care is considered the gold standard, sacrosanct. Yet all who are involved with it know that it is highly imperfect, fraught with errors, biases and sometimes fraud. Yet, as pointed out in this article, the process itself has never been subjected to critical analysis. Dr. Adler, an experienced academic neurosurgeon, does so in this article with a fascinating suggestion for improvement.

The CDC has released new data suggesting a rise in opioid (“painkiller”) overdose rates in women. Clearly, the situation with prescribing opioids for pain control is serious and requires careful consideration. Nevertheless, good medicine mandates caution in order to prevent over-reaction with unintended consequences. The lesson is that health care providers have to be careful – as with most medications – and may, at times, have to make difficult choices and have difficult conversations with patients. But creating poorly considered legislation and/or mandating options that fail to recognize the very real potential good that these medications can do is not the right path. Many patients will suffer if there is not rational planning for how to provide the right medication, in the right amount, to the right patient.

An elderly man with widely metastatic prostate cancer and severe pain in several locations. We did a ‎radiosurgical ‎hypophysectomy (noninvasive, outpatient removal of pituitary gland using radiation) and he experienced immediate, near total pain relief. After several days, he had reduced pain medication from almost 500 mg morphine equivalents per day (in severe pain) to under 360 mg morphine equivalents per day (comfortable). Another option for severe ‎cancer ‎pain.